Monday, June 22, 2009

In the weeks following the assassination of Wichita abortion provider Dr. George Tiller, it was perhaps too much to hope that antiabortion organizations and activists would reflect on, and even temper, their movement’s rhetoric. Instead, the halfhearted denunciations of violence issued by groups like the National Right to Life Committee and Operation Rescue were all too quickly followed by a return to offensive characterizations not only of abortion, but of abortion providers.

While the most harmful expressions of antiabortion violence are playing out here in the United States, the vigorous export of the rhetoric, tactics and ideology of the movement is creating a similar hostile environment for abortion providers and for women seeking abortions in other countries. Legal attacks and harassment against clinics, women and providers in countries where women risk their lives to end a pregnancy are increasing, largely tolerated by governments who are reluctant to confront powerful religious leaders.

In many ways the U.S. antiabortion movement is succeeding in recreating the intimidating American model abroad. Take, for example, the 2007 police raid on a family planning clinic in Brazil, which was eerily reminiscent of the raids on Dr. Tiller’s clinic in Wichita. In both cases, the private medical records of thousands of women were confiscated and searched for evidence of illegal abortions. Prosecutors felt that the possibility that any of them might have had an illegal abortion far outweighed their right to keep their medical records private.

Similar attitudes can be seen at the national level where conservative antiabortion legislators recently submitted a proposal to the Brazilian Congress seeking to define abortion as a “heinous crime.” This came just months after their caucus, the Parliamentary Front in Defense of Life, pushed for the approval of a congressional committee dedicated to investigating illegal abortions and the black market sale of abortive drugs “in order to implement the law to the fullest extent.” If found guilty, women who undergo illegal abortions could receive one-to-three years imprisonment, and physicians up to 20 years.

Even where abortion is legal, activists are applying the same tactics of intimidation seen here in United States. Last year the Mexico City legislature approved a progressive reproductive health bill allowing abortion for up to twelve weeks. A legal appeal (supported by the country’s Catholic hierarchy) quickly followed but was denied by the Mexican Supreme Court. Antiabortion activists sprung into full attack mode, protesting clinics wielding massive posters of bloodied, mangled full-term babies who they claimed were the victims of abortion. They continue to film, intimidate and harass women entering clinics for legal services, begging them not to get an abortion.

With the exception of a few countries, most nations in the world allow abortion for at least some indications. Still, abortion stigma is so culturally pervasive that many women do not use legal facilities to terminate their unwanted pregnancies but instead self-induce under dangerous conditions. Because of the stigma, governments have little incentive to ensure that legal services are available and many doctors are unaware that women have the right to request legal abortions in their hospitals and clinics. Instead, antiabortion organizations use their political influence and dangerous rhetoric to punish and endanger women.

In this country we can observe in the wake of Tiller’s murder a certain reinvigoration of the antichoice movement. Rather than stepping back to evaluate how they contribute to hostility toward women and providers, the anti-abortion movement is continuing to stick to its message. The repeated refrain is that they don’t condone Tiller’s killing but that, after all, he “murdered unborn children.”

Human Life International (HLI), a Virginia-based organization that claims it is “the largest prolife movement of Catholic orientation in the world,” is a perfect example of this global approach. They are clearly not ready to tamp down on its war of words. Indeed, their public statement following Tiller’s murder offers no apology:

George Tiller, the mass murderer of Wichita, Kansas is dead. “Those who live by the sword, die by the sword,” said the Lord… Can killing a mass murderer be considered “justifiable homicide”? The short answer to this is “no,” but it is not always apparent why HLI provides financial and material support to affiliates around the world to pressure governments to reject liberalizing abortion laws, while simultaneously creating a cultural climate that stigmatizes abortion and the women who get them. Its activities are focused on the developing world where abortion is already legally restricted (including in Mexico and Brazil), and where women often risk their lives to end an unwanted pregnancy.

Given the history of U.S. antichoice organizations working to recreate the hostile social environment around abortion abroad, is it just a matter of time before a Scott Roeder appears in South Africa or India?

Tuesday, June 9, 2009

The Witchita, Kan., abortion clinic run by murdered doctor George Tiller will be closed permanently, the Tiller family announced Tuesday as Rep. Louise Slaughter, D-N.Y., offered a House resolution honoring the slain abortion provider.

Tiller opened the Women's Health Care Services, Inc., in the 1970s and it served as one of three clinics in the country that performed controversial second- and third-term abortions.

"Notice is being given today to all concerned that the Tiller family is ceasing operation of the clinic and any involvement by family members in any other similar clinic," Tiller family attorneys Lee Thompson and Dan Monnat said in a statement.

"We are proud of the service and courage shown by our husband and father and know that women's health care needs have been met because of his dedication and service. That is a legacy that will never die. The family will honor Dr. Tiller's memory through private charitable activities," the attorneys said.

Tiller, who in March was acquitted on 19 misdemeanor charges related to his practice, was fatally shot while serving as an usher in his church on May 31. The murder drew a flood of denunciations from President Obama along with liberal and conservative lawmakers and abortion rights groups and abortion foes.

Attorney General Eric Holder ordered the U.S. Marshals' service to "increase security for a number of individuals and facilities" although officials provided no specifics.

Scott Roeder, 51, was taken into custody for the crime.

On Tuesday, Slaughter offered a resolution condemning Tiller's murder on behalf of 80 co-sponsors. The resolution noted the increased acts of violence taking place in places of worship, and called for condolences to the Tiller family and a recommitment to tolerance.

What follows are remarks delivered by Canadian abortion doctor Garson Romalis on Jan. 25, at the University of Toronto Law School's Symposium to Mark the 20th Anniversary of R. vs. Morgentaler

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I am honoured to be speaking today, and honored to call Henry Morgentaler my friend.

I have been an abortion provider since 1972. Why do I do abortions, and why do I continue to do abortions, despite two murder attempts?

The first time I started to think about abortion was in 1960, when I was in secondyear medical school. I was assigned the case of a young woman who had died of a septic abortion. She had aborted herself using slippery elm bark.

I had never heard of slippery elm. A buddy and I went down to skid row, and without too much difficulty, purchased some slippery elm bark to use as a visual aid in our presentation. Slippery elm is not sterile, and frequently contains spores of the bacteria that cause gas gangrene. It is called slippery elm because, when it gets wet, it feels slippery. This makes it easier to slide slender pieces through the cervix where they absorb water, expand, dilate the cervix, produce infection and induce abortion. The young woman in our case developed an overwhelming infection. At autopsy she had multiple abscesses throughout her body, in her brain, lungs, liver and abdomen.

I have never forgotten that case.

After I graduated from University of British Columbia medical school in 1962, I went to Chicago, where I served my internship and Ob/Gyn residency at Cook County Hospital. At that time, Cook County had about 3,000 beds, and served a mainly indigent population. If you were really sick, or really poor, or both, Cook County was where you went.

The first month of my internship was spent on Ward 41, the septic obstetrics ward. Yes, it's hard to believe now, but in those days, they had one ward dedicated exclusively to septic complications of pregnancy.

About 90% of the patients were there with complications of septic abortion. The ward had about 40 beds, in addition to extra beds which lined the halls. Each day we admitted between 10-30 septic abortion patients. We had about one death a month, usually from septic shock associated with hemorrhage.

I will never forget the 17-year-old girl lying on a stretcher with 6 feet of small bowel protruding from her vagina. She survived.

I will never forget the jaundiced woman in liver and kidney failure, in septic shock, with very severe anemia, whose life we were unable to save.

Today, in Canada and the U.S., septic shock from illegal abortion is virtually never seen. Like smallpox, it is a "disappeared disease."

I had originally been drawn to obstetrics and gynecology because I loved delivering babies. Abortion was illegal when I trained, so I did not learn how to do abortions in my residency, although I had more than my share of experience looking after illegal abortion complications.

In 1972, a couple of years after the law on abortion was liberalized, I began the practise of obstetrics and gynecology, and joined a three-man group in Vancouver. My practice partners and I believed strongly that a woman should be able to decide for herself if and when to have a baby. We were frequently asked to look after women who needed termination of pregnancy. Although I had done virtually no terminations in my training, I soon learned how. I also learned just how much demand there was for abortion services.

Providing abortion services can be quite stressful. Usually, an unplanned, unwanted pregnancy is the worst trouble the patient has ever been in in her entire life.

I remember one 18-year-old patient who desperately wanted an abortion, but felt she could not confide in her mother, who was a nurse in another Vancouver area hospital. She impressed on me how important it was that her termination remain a secret from her family. In those years, parental consent was required if the patient was less than 19 years old. I obtained the required second opinion from a colleague, and performed an abortion on her.

About two weeks, later I received a phone call from her mother. She asked me directly "Did you do an abortion on my daughter?" Visions of legal suit passed through my mind as I tried to think of how to answer her question. I decided to answer directly and truthfully. I answered with trepidation, "Yes, I did" and started to make mental preparations to call my lawyer. The mother replied: "Thank you, Doctor. Thank God there are people like you around."

Like many of my colleagues, I had been the subject of antiabortion picketing, particularly in the 1980s. I did not like having my office and home picketed, or nails thrown into my driveway, but viewed these picketers as a nuisance, exercising their right of free speech. Being in Canada, I felt I did not have to worry about my physical security.

I had been a medical doctor for 32 years when I was shot at 7:10 a.m., Nov. 8, 1994. For over half my life, I had been providing obstetrical and gynecological care, including abortions. It is still hard for me to understand how someone could think I should be killed for helping women get safe abortions.

I had a very severe gun shot wound to my left thigh. My thigh bone was fractured, large blood vessels severed, and a large amount of my thigh muscles destroyed. I almost died several times from blood loss and multiple other complications. After about two years of physical and emotional rehabilitation, with a great deal of support from my family and the medical community, I was able to resume work on a part-time basis. I was no longer able to deliver babies or perform major gynecological surgery. I had to take security measures, but I continued to work as a gynecologist, including providing abortion services. My life had changed, but my views on choice remained unchanged, and I was continuing to enjoy practicing medicine. I told people that I was shot in the thigh, not in my sense of humour.

Six years after the shooting, on July 11, 2000, shortly after entering the clinic where I had my private office, a young man approached me. There was nothing unusual about his appearance until he suddenly got a vicious look on his face, stabbed me in the left flank area and then ran away.

This could have been a lethal injury, but fortunately no vital organs were seriously involved, and after six days of hospital observation I was able to return home. The physical implications were minor, but the security implications were major. After two murder attempts, all my security advisors concurred that I was at increased risk for another attack.

My family and I had to have some serious discussions about my future. The National Abortion Federation provided me with a very experienced personal security consultant. He moved into our home and lived with us for three days, talked with us, assessed my personality, visited the places that I worked in and gave me security advice. In those three days, he got to know me well. After he finished his evaluation, when I was dropping him off at the airport, his departing words to me were "Gary, you have to go back to work."

About two months after the stabbing, I returned to the practise of medicine, but with added security measures. Since the year 2000, I have restricted my practise exclusively to abortion provision.

These acts of terrorist violence have affected virtually every aspect of my and my family's life. Our lives have changed forever. I must live with security measures that I never dreamed about when I was learning how to deliver babies.

Let me tell you about an abortion patient I looked after recently. She was 18 years old, and 18-19 weeks pregnant. She came from a very strict, religious family. She was an only daughter, and had several brothers. She was East Indian Hindu and her boyfriend was East Indian Muslim, which did not please her parents. She told me if her parents found out she was pregnant she would be disowned and kicked out of the family home. She also told me that her brothers would murder her boyfriend, and I believed her. About an hour after her operation I and my nurse saw her and her boyfriend walking out of the clinic hand in hand, and I said to my nurse, "Look at that. We saved two lives today."

I love my work. I get enormous personal and professional satisfaction out of helping people, and that includes providing safe, comfortable, abortions. The people that I work with are extraordinary, and we all feel that we are doing important work, making a real difference in peoples' lives.

I can take an anxious woman, who is in the biggest trouble she has ever experiences in her life, and by performing a five-minute operation, in comfort and dignity, I can give her back her life.

After an abortion operation, patients frequently say "Thank You Doctor." But abortion is the only operation I know of where they also sometimes say "Thank you for what you do."

I want to tell you one last story that I think epitomizes the satisfaction I get from my privileged work. Some years ago I spoke to a class of University of British Columbia medical students. As I left the classroom, a student followed me out. She said: "Dr. Romalis, you won't remember me, but you did an abortion on me in 1992. I am a secondyear medical student now, and if it weren't for you I wouldn't be here now."